Psychotic Disorder Due to Another Medical Condition
DSM-IV In DSM-IV, this disorder is called Psychotic Disorder Due to a General Medical Condition For more information, see Mental Disorders Due to a General Medical Condition Diagnostic Criteria A'''. Prominent hallucinations or delusions. '''B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition. C'''. The disturbance is not better accounted for by another mental disorder. '''D. The disturbance does not occur exclusively during the course of a delirium. Specify predominant symptom: * With Delusions: if delusions are the predominant symptom * With Hallucinations: if hallucinations are the predominant symptom Note: Include the name of the general medical condition, e.g., Psychotic Disorder Due to Malignant Lung Neoplasm, With Delusions; also record the general medical condition. Note: If delusions are part of a preexisting dementia, indicate the delusions by recording the appropriate subtype of the dementia if one is available, e.g., Dementia of the Alzheimer's Type, With Late Onset, With Delusions. Subtypes One of the following subtypes may be used to indicate the predominant symptom presentation. If both delusions and hallucinations are present, record whichever is predominant: With Delusions This subtype is used if delusions are the predominant symptom. With Hallucinations This subtype is used if hallucinations are the predominant symptom. Recording Procedures In recording the diagnosis of Psychotic Disorder Due to a General Medical Condition, the clinician should first note the presence of the Psychotic Disorder, then the identified general medical condition judged to be causing the disturbance, and finally the appropriate specifier indicating the predominant symptom presentation (e.g., Psychotic Disorder Due to Thyrotoxicosis, With Hallucinations). The general medical condition should also be noted (e.g., thyrotoxicosis). Associated General Medical Conditions A variety of general medical conditions may cause psychotic symptoms, including neurological conditions (e.g., neoplasms, cerebrovascular disease, Huntington's disease, epilepsy, auditory nerve injury, deafness, migraine, central nervous system infections), endocrine conditions (e.g., hyper- and hypothyroidism, hyper- and hypoparathyroidism, hypoadrenocorticism), metabolic conditions (e.g., hypoxia, hypercarbia, hypoglycemia), fluid or electrolyte imbalances, hepatic or renal diseases, and autoimmune disorders with central nervous system involvement (e.g., systemic lupus erythematosus). Those neurological conditions that involve subcortical structures or the temporal lobe are more commonly associated with delusions. The associated physical examination findings, laboratory findings, and patterns of prevalence or onset reflect the etiological general medical condition. Differential Diagnosis Delirium and Dementia Hallucinations and delusions commonly occur in the context of a delirium; however, a separate diagnosis of Psychotic Disorder Due to a General Medical Condition is not given if the disturbance occurs exclusively during the course of a delirium. When delusions develop during the course of Dementia of the Alzheimer's Type or Vascular Dementia, a diagnosis of Dementia of the Alzheimer's Type or Vascular Dementia with the subtype With Delusions is given; a separate diagnosis of Psychotic Disorder Due to a General Medical Condition is not given. Anxiety Disorder Due to a General Medical Condition If the presentation includes a mix of different types of symptoms (e.g., psychotic and anxiety), the diagnosis is usually Psychotic Disorder Due to a General Medical Condition because in such situations psychotic symptoms typically predominate in the clinical picture. Substance-Induced Psychotic Disorder If there is evidence of recent or prolonged substance use (including medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin (e.g., LSD Intoxication, Alcohol Withdrawal), a Substance-Induced Psychotic Disorder should be considered. It may be useful to obtain a urine or blood drug screen or other appropriate laboratory evaluation. Symptoms that occur during or shortly after (i.e., within 4 weeks of) Substance Intoxication or Withdrawal or after medication use may be especially indicative of a Substance-Induced Psychotic Disorder, depending on the character, duration, or amount of the substance used. If the clinician has ascertained that the disturbance is due to both a general medical condition and substance use, both diagnoses (i.e., Psychotic Disorder Due to a General Medical Condition and Substance-Induced Psychotic Disorder) can be given. Primary Psychotic Disorder and primary Mood Disorder With Psychotic Features Psychotic Disorder Due to a General Medical Condition must be distinguished from a primary Psychotic Disorder (e.g., Schizophrenia, Delusional Disorder, Schizoaffective Disorder) or a primary Mood Disorder With Psychotic Features. In primary Psychotic Disorders and in primary Mood Disorders With Psychotic Features, no specific and direct causative physiological mechanisms associated with a general medical condition can be demonstrated. Late age at onset (e.g., the first appearance of delusions in an individual over age 35 years) and the absence of a personal or family history of Schizophrenia or Delusional Disorder suggest the need for a thorough assessment to rule out the diagnosis of Psychotic Disorder Due to a General Medical Condition. Auditory hallucinations that involve voices speaking complex sentences are more characteristic of Schizophrenia than of Psychotic Disorder Due to a General Medical Condition. Other types of hallucinations (e.g., visual, olfactory) commonly signal a Psychotic Disorder Due to a General Medical Condition or a Substance-Induced Psychotic Disorder. Psychotic Disorder Not Otherwise Specified Psychotic Disorder Not Otherwise Specified is diagnosed when the clinician cannot determine if the psychotic disturbance is primary, substance induced, or due to a general medical condition. Hypnagogic and hypnopompic hallucinations Hypnagogic and hypnopompic hallucinations may occur in individual without a mental disorder, but they occur only on falling asleep or on awakening. DSM-5 Diagnostic Criteria A'''. Prominent hallucinations or delusions. '''B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. C'''. The disturbance is not better explained by another mental disorder. '''D. The disturbance does not occur exclusively during the course of a delirium. E'. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. ''Specify whether: * '''With delusions: If delusions are the predominant symptom. * With hallucinations: If hallucinations are the predominant symptom. Note: Include the name of the other medical condition in the name of the mental disorder (e.g., psychotic disorder due to malignant lung neoplasm, with delusions). The other medical condition should be listed separately immediately before the psychotic disorder due to the medical condition (e.g., malignant lung neoplasm; psychotic disorder due to malignant lung neoplasm, with delusions). Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). Note: Diagnosis of psychotic disorder due to another medical condition can be made without using this severity specifier. Specifiers In addition to the symptom domain areas identified in the diagnostic criteria, the assessment of cognition, depression, and mania symptom domains is vital for making critically important distinctions between the various schizophrenia spectrum and other psychotic disorders. Differential Diagnosis Delirium Hallucinations and delusions commonly occur in the context of a delirium; however, a separate diagnosis of psychotic disorder due to another medical condition is not given if the disturbance occurs exclusively during the course of a delirium. Delusions in the context of a major or mild neurocognitive disorder would be diagnosed as major or mild neurocognitive disorder, with behavioral disturbance. Substance/medication-induced psychotic disorder If there is evidence of recent or prolonged substance use (including medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin (e.g., LSD acid diethylamide intoxication, alcohol withdrawal), a substance/medication-induced psychotic disorder should be considered. Symptoms that occur during or shortly after (i.e., within 4 weeks) of substance intoxication or withdrawal or after medication use may be especially indicative of a substance-induced psychotic disorder, depending on the character, duration, or amount of the substance used. If the clinician has ascertained that the disturbance is due to both a medical condition and substance use, both diagnoses (i.e., psychotic disorder due to another medical condition and substance/medication-induced psychotic disorder) can be given. Psychotic disorder Psychotic disorder due to another medical condition must be distinguished from a psychotic disorder (e.g., schizophrenia, delusional disorder, schizoaffective disorder) or a depressive or bipolar disorder, with psychotic features. In psychotic disorders and in depressive or bipolar disorders, with psychotic features, no specific and direct causative physiological mechanisms are associated with a medical condition can be demonstrated. Late age at onset and the absence of a personal or family history of schizophrenia or delusional disorder suggest the need for a thorough assessment to rule out the diagnosis of psychotic disorder due to another medical condition. Auditory hallucinations that involve voices speaking complex sentences are more characteristic of schizophrenia than of psychotic disorder due to a medical condition. Other types of hallucinations (e.g., visual, olfactory) commonly signal a psychotic disorder due to another medical condition or a substance/medication-induced psychotic disorder.